Provider Demographics
NPI:1649202854
Name:LANGE, KIMBERLY (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PLEASANT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3917
Mailing Address - Country:US
Mailing Address - Phone:413-582-9889
Mailing Address - Fax:413-582-9886
Practice Address - Street 1:300 PLEASANT ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3917
Practice Address - Country:US
Practice Address - Phone:413-582-9889
Practice Address - Fax:413-582-9886
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2720111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA Y45824Medicare ID - Type Unspecified